Quaker House
Requires improvement

Reports

Inspection carried out on 17 October 2017

During a routine inspection

Quaker House offers accommodation for up to 40 older people. We carried out an unannounced inspection on 17, 19 & 20 October 2017. Thirty-one people were living in the home at the time of the inspection.

At our inspection in October 2016 we identified the provider was not meeting three regulations. Risk assessments were not always completed and regularly reviewed and actions were not taken to mitigate risks. Staff had not always followed safeguarding guidance to ensure people were protected from abuse or harm. Records in respect of people living at the home were not always accurate and up to date and the provider had not maintained appropriate oversight of the service. At this inspection we found that there was still some work to do to ensure risks to people were safely managed and the effectiveness of record keeping, which was sometimes out of date and did not reflect people’s current needs. We also found three new breaches of Regulations relating to people’s nutritional needs, the need for consent and person centred care.

The home had been through three management changes since our last inspection. At our inspection in October 2017 we found a new interim manager was in post until a new registered manager could be appointed. An advertisement went out for a registered manager the week after our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the home. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the home is run.

Initial assessments were carried out before people moved into Quaker House to ensure their needs could be met. Care plans were not always up to date and did not always reflect their current care needs.

Individual risks relating to people’s health, safety and welfare had not always been completed or adequately reviewed to identify, assess and reduce those risks.

Although staff received training to administer medicines and were assessed for competency, people had not always received their medicines at the correct time, and in some cases, they had not received their medicines at all. The interim manager had requested to the Board of Trustees to change the medicines management system.

People were not always supported to eat an appropriate diet that met their assessed nutritional needs and people’s food preferences were not always supported.

Not all staff understood and followed the principles of the Mental Capacity Act 2005 designed to protect people’s rights and ensure decisions were made in their best interests.

Most people told us there was not enough to keep them occupied and they were often bored. Staff confirmed they were often too busy providing care and did not have time to provide regular social or physical activities. There were sufficient staff deployed to meet people’s care and support needs.

People and relatives told us they felt the home was safe. Staff understood how to identify abuse and explained the action they would take if they identified any concerns. However, not all staff knew how to report concerns to external agencies such as the Care Quality Commission.

Some recruitment checks required improvement to ensure that only suitable staff were employed.

Staff had not all received appropriate supervision, appraisal and training in line with the provider’s policy although actions had been taken to address this.

The manager had a good understanding of their responsibilities in relation to meeting the Health and Social Care Act 2008 regulations. They had notified us appropriately of events required by law.

Systems were in place to monitor and assess the quality and safety within the home although this was a work in progress and recent action plans had not yet been implemented.

Incidents and accidents had been investigated and learning shared with staff.

People were supported to maintain their health and well-being and had access to a range of healthcare services when they needed them.

Staff interacted with people with kindness and care. Staff treated people with dignity and respect and ensured their privacy and independence was promoted.

Friends and family were able to visit their loved ones at any time and felt welcomed by staff.

Residents meetings took place and enabled people to share their views about the service. People and relatives knew how to raise concerns and would do so if they needed to.

Staff felt supported by the interim manager who provided clear leadership and direction. Staff felt able to raise any issues or concerns with them and felt listened to and involved.

We identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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During a routine inspection

This inspection took place on 25 and 26 October 2016 and was unannounced.

Quaker House is a purpose built residential care home for up to 40 older persons. It is located in a quiet residential area, close to the centre of New Milton. The registered provider is New Forest Quaker Home Limited who is also a registered charity run by a board of Trustees. The Trustees meet on a regular basis to discuss and decide on all issues concerning Quaker House. At the time of our inspection there were 29 people living at the home. The home provides both short and long term residential care and day services. It does not provide nursing care or specialist support for people living with dementia or those who might display behaviour which might challenge others.

The home is arranged over two floors which are accessed by stairs, a stair lift or a passenger lift. There are three communal lounges and a dining room. The 40 single rooms all have ensuite facilities. There are bathrooms and a shower room on each floor and kitchenettes with fridges where residents can make their own food and drinks. Many of the people living at the home were generally quite independent and only required minimal support with some aspects of personal care or support with their medicines management and the provision of meals. Some were able to use their mobility scooters to visit the town centre and storage for these was provided.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

Some areas required improvement. Staff displayed a commitment to protect people from harm and to protect them from abuse. However, potential safeguarding concerns had not been appropriately escalated to the local authority safeguarding teams.

The service did not have a structure to continuously monitor incidents, accidents or near misses for any trends or patterns that might allow actions to be taken to prevent similar incidents from happening again. Audits were not undertaken on a regular basis to measure the delivery of care, treatment and support given to people against current guidance.

Staff had not always taken appropriate steps to identify and mitigate risks to people’s wellbeing and safety and improvements were needed to ensure that all aspects of medicines were managed safely.

People and their relatives were positive about the care and support they received. Staff knew people well and understood how to meet their individual needs. However, some people’s care plans needed to be updated. Others needed to include more detailed and specific guidance about how to meet people’s needs.

There were sufficient numbers of experienced staff deployed to meet people’s needs at this time. The level of dependency of people using the service was increasing however, and so the registered manager would benefit from having a more systematic approach to determining staffing levels. We have made a recommendation about this.

Staff had received an induction and on-going training. However, the registered manager was not able to demonstrate that staff had received an annual appraisal. Supervision had also not been taking place on a regular basis. This was however, an improving picture.

Additional training was needed to help ensure that going forward staff fully understood the key principles of the MCA 2005 and how and when it might be appropriate to apply for a DoLS.

People were positive about the quality of food provided. They received a choice of meals and were supported to have a nutritious diet.

Staff had developed effective working relationships with local healthcare professionals to ensure that people received co-ordinated care, treatment and support.

People told us they were cared for by kind and caring staff who respected their choices, their privacy and dignity and encouraged them to retain their independence.

People received care that was responsive to their needs. Staff knew people well and had a good knowledge of their likes and dislikes.

People enjoyed the activities provided but felt further improvements could be made to ensure the activities remained relevant and were in keeping with their interests and wishes

People told us they were able to raise any issues or concerns and felt these would be dealt with promptly.

People spoke positively about the registered manager who had a good knowledge about the people being cared for within the service.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

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During a routine inspection

We were assisted throughout the inspection by the registered manager and members of staff. We spoke with eight people who lived at the home, three members of staff and with one person, who was about to move into the home and their relative.

People’s privacy dignity and independence was respected and promoted. People living at the home told us that they were fully involved in their care, that they were listened to and their choices and preferences respected.

People’s care and welfare needs were being met. Assessments had been carried out and care plans put in place so that staff knew how to support people.

The home had robust recruitment procedures in place that were being followed to ensure that suitable members of staff were employed to work at the home.

The home had effective systems in place to monitor the quality of service provided to people living at Quaker house.

Records were maintained on behalf of people. These were up to date, accurate and stored confidentially.

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During a routine inspection

At this inspection we spoke with ten people who lived at the home, two members of staff, the registered manager and briefly with a member of the Board of New Milton Quaker Housing Association. Everyone we spoke with had positive things to say about the home, from the standards of care, the way the home was managed to the approach and support of staff.

People told us that they were consulted about their care and the way the home was run.

They told us their care needs were met by the staff team and that the home was well managed.

Staff we spoke with told us that they were felt supported by the management and that training was provided to make sure they were competent and knowledgeable.

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During a routine inspection

People told us they received a good service from staff. They liked living at the home and were encouraged to remain independent .They said there were lots of activities to provide mental stimulation and support was available when they needed it.

Inspection ratings

We rate most services according to how safe, effective, caring, responsive and well-led they are, using four levels:

Outstanding – the service is performing exceptionally well.

Good – the service is performing well and meeting our expectations.

Requires improvement – the service isn't performing as well as it should and we have told the service how it must improve.

Inadequate – the service is performing badly and we've taken enforcement action against the provider of the service.

No rating/under appeal/rating suspended – there are some services which we can’t rate, while some might be under appeal from the provider. Suspended ratings are being reviewed by us and will be published soon.

Ticks and crosses

We don't rate every type of service. For services we haven't rated we use ticks and crosses to show whether we've asked them to take further action or taken enforcement action against them.

There's no need for the service to take further action. If this service has not had a CQC inspection since it registered with us, our judgement may be based on our assessment of declarations and evidence supplied by the service.

The service must make improvements.

At least one standard in this area was not being met when we inspected the service and we have taken enforcement action.